E.O. 11644 - Use of Off-Road Vehicles on the Public Lands

(14) TRAVEL PLAN

List or code all zones to be traversed, in sequence of travel, and number of nights to

be spent in each zone.

In areas where specific campsites are assigned, list and code each site and the

number of nights assigned.

TRAVEL

ZONES

(or campsite)

NIGHTS

U.S. Department of Agriculture

Forest Service

VISITOR’S PERMIT

(Ref. FSM 2323)

FORM APPROVED

OMB NO. 0596-0019

EXPIRES 01/2010

WHEN SIGNED, THIS SINGLE – VISITOR PERMIT AUTHORIZES

(1) NAME (First, Middle Initial, and Last)

(2) MAILING ADDRESS (Optional)

(3) CITY AND STATE

(4)

ZIP

CODE

(5) TO VISIT (and to build campfires in accordance with regulations)

From

month/day

(6) DATES (Give best estimates of start and finish dates)

Through

month/day

(7) LOCATION OF ENTRY POINT

(8) LOCATION OF EXIT POINT

(9) PRIMARY METHOD OF TRAVEL

(15) (a) NUMBER OF TIMES YOU VISITED THIS AREA IN PAST 10 YEARS (Enter appropriate code)

(10) NUMBER OF PEOPLE IN GROUP

□

NONE

□

TWICE

□

FOUR

□

ONCE

□

THREE

□

FIVE OR MORE

(11) NUMBER OF PACK AND SADDLE STOCK

(15) (b) IS VISITING THIS AREA (Enter appropriate code)

(12) NUMBER OF WATERCRAFT OR VEHICLES

(Check Regulations – Vehicles not allowed in many permit areas)

OPTIONAL

□ THE PRIMARY PURPOSE OF YOUR TRIP AWAY FROM HOME?

□ ONE OF SEVERAL IMPORTANT THINGS YOU PLANNED TO DO ON YOUR TRIP?

□ S

ETHING YOU DECIDED TO DO AFTER ARRIVING NEAR THE AREA?

OM

I agree to abide by all laws, rules and regulations which apply to this area and will do my best to see that everyone in our group

does likewise.

(16) REMARKS

(13) VISITOR’S SIGNATURE

DATE

(17) ISSUING OFFICER’S SIGNATURE

FOREST

CODE

OFFICE CODE

VISITOR’S MUST HAVE THIS PERMIT IN POSSESSION DURING STAY IN REQUIRED PERMIT AREAS

FS-2300-30 (11/96)

BURDEN AND NONDISCRIMINATION STATEMENTS

According to the Paperwork Reduction Act of 1995, an agency may not conduct

or sponsor, and a person is not required to respond to a collection of information

unless it displays a valid OMB control number. The valid OMB control number

for this information collection is 0596-0019. The time required to complete this

information collection is estimated to average 3 minutes per response.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its

programs and activities on the basis of race, color, national origin, gender,

religion, age, disability, political beliefs, sexual orientation, and marital or family

status. (Not all prohibited bases apply to all programs.) Persons with disabilities

who require alternative means for communication of program information

(Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at

202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights,

1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800)

795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity

provider and employer.